2. May I have my (insert loaned item such as pen, stethescope, chart) back now?

3. How long will you be sitting at (my) computer and when can I have (my) chair back?

4. Do you believe in hand washing?

5. So, do you REALLY like your job? The nurses? Your patients?

6. If you could change professions, would you?

7. Did you used to have nice handwriting?

8. Honestly, what would you do without nurses?

9. Did you really just do that, say that, write that order, and/or act like that in front of a patient? (Actually, I DO ask this question a lot!)

And last but not least:

10. Are you as tired as you look???

Now I need a list of “Top Ten Reasons I Keep My Mouth Shut!”

Instead of seeing it as one more thing to cross off your to-do list, what if you considered it a vital means of communication? After all, isn’t that the original purpose of charting?

In this four-part series, Dr. Brady and Nurse Rebekah explain what conspiring has to do with charting—and show you how conspiring with your colleagues can keep you out of court.

Dr. Brady: No, I’m not planning on writing a book called The ER Conspiracy. The books I write are actually all about doing your job better. In fact, by “conspire” I don’t mean the first definition in Merriam-Webster’s dictionary, which is to scheme or plot, but rather the second, which is more true to the verb’s etymology: from the Anglo-French conspirer, from the Latin conspirare, to be in harmony; conspire, from con = together + spirare = to breathe. The second definition is “To act in harmony toward a common end.” People, I just want us all to be in harmony and “breathe together.”

In medicine, we need to conspire or collaborate more. When different healthcare providers act together in harmony, patients will more likely be satisfied, rather than confused—and if something goes wrong and we all end up in court together, we’ll be less likely to have helped the plaintiff’s attorney.

Why will patients be more satisfied? The reason is simple. If everyone tells a patient something different, she doesn’t know whom to trust and gets confused.

Here’s an example. A patient comes in with cough and shortness of breath. The ER nurse does her assessment and tells the patient it’s probably a virus, but that she needs a chest x-ray to be sure. Then the ER doctor comes in, does her assessment and tells the patient it’s probably a virus and she doesn’t need a chest x-ray or any antibiotics.

Two days later, she’s not better and goes to her doctor, who tells her she has bronchitis but doesn’t need an x-ray, and writes her a prescription for antibiotics. If she’s in the top fifth percentile for IQ, she’ll probably realize that differences of opinion are not uncommon in certain conditions. If she’s like the other 95 percent of your patients, she’ll probably be confused and assume that two of the three people who gave her advice are incompetent. If only everyone had acted in harmony, the patient might have instead been satisfied and content while the virus ran its course and she recovered completely.

Nurse Rebekah: Most of us want to be the expert at something in our lives. Some people just pretend like they’re experts on everything—which we all know is totally implausible. (My hubby calls these people “Mr. SMITH,” which stands for Smartest Man In The Hemisphere. Try that on your next know-it-all…it’s hilarious.) But many people spend the majority of their lives honing their craft, knowledge and career. Whether you’re a working nurse or doctor, a Starbucks employee or an electrician, at some point you’ll probably know more than other people who may or may not be in your field, and your advice will be sought out. Therefore, because people are seeking your advice, you should make sure you know what you’re talking about—and if you DON’T know what you’re talking about, heed my mother’s advice to “keep your pie hole shut.”

I say this because patients look to us for guidance about their health. Sure, they may have had a prior appointment with Dr. Google, but they’re looking for your professional opinion. Stick to the facts. Using Dr. Brady’s example, I might say, “Mrs. Smith, because of your cough and fever, I’m going to order a chest x-ray per our protocol to expedite your care in the emergency room. The doctor will look at it and tell you what he thinks.” Leave it at that. Don’t claim virus or bacteria—because unless you brought your microscope with you, you won’t be able to defend that claim. And the physician should have the foresight to look in the chart and not say, “Oh, I don’t need a chest x-ray…why did that silly nurse order that?” Don’t staff-split. Leave that to the psych patients and four-year-olds.

Starting to get the idea? Only say—and write—exactly what you observe. Anything more is just speculation and can confuse and frustrate both patients and staff. Part II of the Charting Conspiracy series underlines the importance of effectively communicating your observations and concerns. Stay tuned!

Fredrik Broden for Scrubs Magazine

Myths and misconceptions abound in every profession, and nursing is no exception. Sometimes these myths come from colleagues, sometimes from people outside the profession—either way, they don’t serve us well.

So, the next time you hear a stereotype you know is nonsense, use your know-how to clarify, inform and enlighten.

Myth: “Real” nurses work in hospitals.
Fact: More than half of all nurses work in hospitals, but that doesn’t make them more “real” than the rest of us.

I used to work in an emergency room, and I can tell you for certain that I am every bit as much a nurse since I left as I was in the hospital (I’ve done everything from conducting medical exams for insurance companies to preparing nurses to take their boards for an education company). Yet from the day I stepped out of the hospital into the world of nontraditional nursing, the questioning (“Why did you leave nursing?”) started. And it has never stopped. I always give the same answer, very calmly and very proudly: “I never left nursing. I’m still a healer, teacher and nurturer.” I have a very broad view of who a nurse is and what a nurse does. While many of us wear scrubs, there are still nurses who wear uniforms, business clothes, even overalls. Being a nurse is about who you are, not about what you wear or where you work.

Myth: You can always tell a good nurse by how much she (or he) knows.
Fact: An excellent store of information and experience is essential in a nurse, no question about it. But a deep sense of empathy and compassion are equally important. A nursing instructor at a community college told me that she always explains to new grads, “Patients don’t care how much you know until they know how much you care.”

Myth: Patients like to be called by their first name. It’s just friendlier.
Fact: With all the available techno-communication—from email and text messaging to Facebook and Twitter—we’ve become an increasingly informal society, and sometimes we automatically address people by their first name. Many patients are more comfortable with formality in the health care setting, and the use of surnames and titles helps maintain the professional relationship. Plus, there are many people, especially older individuals, who consider it disrespectful to be addressed by their first name. The bottom line: Be sensitive to your patients’ preferences. It’s probably safest to start out with formal forms of address and progress from there.

Myth: Apart from the language issue, most foreign-trained nurses find that working in an American hospital is not much different from working in their home country.
Fact: Foreign-trained nurses now account for about five percent of the total United States nursing workforce, and are an intrinsic part of our health care system. Thank goodness, because there are some parts of our country that are suffering from a nursing shortage. Most foreign-trained nurses, despite their high skill level and excellent training, still have to sort out a host of cultural issues and professional expectations that they often hadn’t expected.

Nurses from the Philippines, for example, who make up nearly half the foreign-trained nurses, usually find they have much more responsibility here. They also have to be more independent and use more critical thinking skills. Why? Because in the Philippines, most hospitals are teaching hospitals, and the residents and medical students do most of the procedures. When they get to the United States, nurses find, for example, that they’re required not only to start IVs, but are also supposed to interact with doctors and patients’ families, even if they’re not the charge nurse; additionally, they’re responsible for discharge planning and case management. Add to all this a brand new language, and you can really see what foreign-trained nurses are up against.

Myth: One of a nurse’s main responsibilities is to help doctors do their jobs better.
Fact: Nurses are not secondary caregivers, but highly educated, skilled and autonomous members of the primary health care team who make independent critical decisions about the care of their patients. While it’s true that some nurses are extremely deferential to doctors, and some doctors are domineering types, those roles are rarely, if ever, the norm.

To read more myths—including the ones about male nurses, nurses eating their young, and the hierarchies of nursing specialties—read the complete story in the 2010 Winter Edition of Scrubs Magazine, available at your local scrubs retailer. Find a retailer who carries Scrubs Magazine here.

Image: Adam Gault/Science Photo Library/Getty Images

It’s not a matter of what they want, but more of what they expect. Maybe it’s both? The bottom line is the nurse and physician have to work together as a team.

Let’s face it, they both play very important roles when caring for the patient, so I won’t sit here and disseminate each of their responsibilities, duties, task, etc. I like to think of the physician and nurse as a team. One cannot do their job to the best of their abilities if the other is not doing their part.

Let me be clear, these days, simply doing your job is not enough. The patients are sicker. The illnesses are more complex. The entire continuum of care has become more challenging. So just showing up for work is not enough – for either one!

If you want to know what the physician wants, maybe we should start with what you as the nurse want from the physician?

Here are a couple things that ALL nurses want from the physician (in my humble opinion):

• Open line of communication
• Treat as a member of the health care team
• Respect
• Trust
• Good mannerisms (goes hand-in-hand with respect)
• Support
• Practice what you preach
• Follow through (do what you say you are going to do)

Guess what? What do you think the physicians’ want from the nurses’?? Yep. The same.

• Open line of communication
• Treat as a member of the health care team
• Respect
• Trust
• Good mannerisms
• Support
• Practice what you preach
• Follow though

Now of course I am over-generalizing, but the message is the same. The physicians and the nurses need to work as a cohesive team in order to deliver the very best patient care and hopefully elicit the most ideal patient outcomes.

Here are some things to keep in mind in regards to the relationship you develop with a physician:

• Their service or their area of practice has no bearing on your relationship. We are all trying to accomplish the same goal.
• In order to gain respect, you must first earn it.
• In order to gain trust, you must first earn it.
• In the name of advocating for your patient, you are never wrong or out of place.
• Unless you want to be the physician’s hand maiden, don’t act like one.
• Professionalism wins over attitude and anger every time.

It’s not difficult to figure out that we nurses have to earn our keep. A physician is more likely to trust your judgment if you come prepared and have done your homework. Don’t call or page a physician unless you have all the facts laid out ahead of time. Never be empty-handed when providing information about your patient to the physician.

They may or may not care about your past experiences/knowledge (or lack there-of), they WILL care if you aren’t prepared.

In the end, it really is not a difficult scenario. We nurses and the physicians somehow like to make it as difficult as possible. I truly believe if you’re actions and judgment originate with patient advocacy you can never go wrong. The patient comes first and foremost. Everything else is a work in progress.

What do you think are the ‘must have’s and ‘must have not’s?

ER Doc Brady Pregerson and Nurse Rebekah are ready to “go there” in the first of a four-part series on pain management.

Dr. Brady: The can of worms I’d like to open up is one that I think raises more hackles than almost any other patient care issue in medicine: the use of narcotics to treat pain.

We’re all well aware of the fact that mixed in with our usual patients is a smattering of those who are addicted to narcotics or, even worse, fill their prescriptions and then sell the drugs on the street.

Prescription drug abuse is becoming a bigger and bigger problem. But oligoanalgesia—the under-use or sometimes non-use of opiates to treat legitimate pain—is also a problem. And we doctors and nurses are caught in the middle of this dilemma.

As a physician, I read in a quarterly newsletter from the Medical Board of California about all of the physicians whose licenses have been revoked or placed on probation. This litany of doctors and their bad deeds is there in black and white as a warning to the rest of us not to stray from the path of Hippocrates.

Each month, a good part of those whose licenses are under restriction have ended up where they are through the inappropriate prescribing of narcotics. Inappropriate narcotic prescription can do more than feed an addiction; it can get you in trouble.

On the other hand, if I don’t treat a patient’s pain appropriately, not only does the patient suffer, but she’ll probably write a letter to my boss. If I mess up either way, there’s trouble.

This wouldn’t be such a big deal if I could accurately gauge pain all of the time, but I can’t. I rely mostly on what my patients say. That’s accurate if they’re telling the truth, but what if they’re lying? You can’t fake hypoxia, you can’t fake hypotension, you can’t fake hyperkalemia or rales or vomiting up blood, but it’s not that hard to fake pain. And as the Bard said, “There’s the rub.”

Nurse Rebekah: I love this hot topic. There is a continuum of people in real pain, people in fake pain, people in pain who refuse to acknowledge the pain, people in pain who acknowledge it too much…the list goes on and on. From my perspective, scaling the pain can prove to be the biggest obstacle.

I love when I’m asking a patient for his pain scale and the following scenario occurs:

Me: “On a scale of zero to ten, ten being the worst pain you’ve ever had in your life and zero being no pain, what would you rate your pain?”

Patient: “Twenty.”

This kills me! I gave you ten integers, eleven if you include zero, and you still go off the scale! You don’t get more pain points if you make up your own pain scale…you probably won’t even get a higher degree out of this faux original research because there are, like, a MILLION pain scales out there.

Or this one:

Me: “On a scale of zero to ten, ten being the worst pain you’ve ever had in your life and zero being no pain, what would you rate your pain?”

Patient: “Uh, I don’t really know…[pause]…lemme think…

[Insert "Jeopardy!" theme here.]

[Ten minutes go by.]

…uh, maybe a five and a half.”

Well, I’ve fallen asleep waiting for the patient to scale his abdominal pain, and his appendix has probably burst by now. I’m so glad he put that much thought into it.

Okay, there’s really no right or wrong answer here. Your pain can be whatever you want it to be (as long as you stay within the 0–10 range; otherwise I get irritated). I won’t yell at you if you lowball or highball your pain. IT IS YOUR PAIN. Embrace it, own it, rate it.

Image: Sam Edwards | OJO Images | Getty Images

Nurse Rebekah Child and Brady Pregerson, MD, good-naturedly debate the claim that nurses are naturally more meticulous by dissecting the medical professional. How? Vis-à-vis an age-old nursery rhyme.

And don’t miss Nurse Rebekah’s homespun technique for ensuring bacteria-free hands (end of article). It’ll have you singing!

Nurse Rebekah: Wanna know my theory about why nurses keep their hands cleaner than doctors? If you do, read on; if you don’t, go and Google, Facebook or Twitter something.

It’s because men are the dominant presence in medicine. According to the AMA, in 2003, men made up 74 percent of the MD workforce, and we all know that the majority of men were once boys, and boys are gross. “Snips and snails and puppy dog tails” is what the famous poem says little boys are made of. Let’s just call a spade a spade here, people. Don’t think I’m male bashing, because I do love all of you guys and your manly ways. But I’m basing these opinions on both anecdotal evidence and hard data. Anecdotally, men spit and blow snot rockets. Scientifically, in a study based on the observations of 6,000 people in various cities, researchers found that one-third of men don’t bother to wash their hands after using the restroom, versus only 12 percent of women.

Dr. Brady: Yes, yes, I know the Mother Goose nursery rhyme: “Sugar and spice and all things nice, that’s what little girls are made of!” I don’t doubt it, and men may spend less time on personal hygiene, but I don’t think that’s the reason why nurses outperform doctors on hand washing. We need a study of male vs. female doctors and male vs. female nurses to figure out that one.

And another thing, perhaps that bathroom study was flawed. If they’re only urinating, many men wash their hands BEFORE rather than after. That’s because we use our hands to hold our urinating organ, and our hands are usually dirtier than our penises, so it makes sense to wash them first. Did your study take that into account?

Nurse Rebekah: Physicians may use bigger words and know more scientific stuff, but they still need to be guided in the ways of cleanliness—because 74 percent of them are male. Therefore, it’s up to us to publicly embarrass them, nag them and/or use brute hand-sanitizer force to get some better compliance. I hate when I see doctors typing at the keyboards with gloves on! TAKE THEM OFF AND WASH YOUR HANDS. Hello, I am NOT your maid and I am not your wife, so I will not pick up your dirty gloves. Throw them in the trash can.

Dr. Brady: We all sometimes need a little reminding; no one is perfect. Medicine—and emergency medicine, in particular—is definitely a team sport, and looking out for your teammates is part of the game. If we’re going to hold hands, let them be clean hands.

Nurse Rebekah: I hope all of us nurses (male and female) get really good at this—for our sake and our patients’ sake. I have a sneaking suspicion that if we don’t get really clear about hand hygiene, the tables may turn as the number of female physicians and male nurses increases. People, I want to live a long time and not catch a URI every four weeks, so let’s all wash our hands please! Plus, it’s a great opportunity to practice your singing (sing “Happy Birthday” twice and you’ve successfully met the mark for the recommended amount of time for sudsing up) or even longingly stare at the clock while you lather, daydreaming about clocking out at the end of your day!

We don’t trust Mother Goose to be the most scientific source, so we invite you to join in the banter by telling us where your workplace weighs in: Are nurses better at handwashing than doctors where you work?

The long hours and extreme situations of a medical environment can lead to more intense closeness than other workplaces. Nurses date nurses, nurses date EMTs, nurses date cafeteria personnel, nurses date custodial staff.

Somehow, though, when nurses do date doctors, that romance is susceptible to more intense scrutiny than other relationships.

Nurses dating doctors is a hot-button issue with real-life repercussions. When you engage in that romance, be prepared for gossip from coworkers, unhappy supervisors and possibly a damaged professional reputation. How? Because no matter how it ends, your colleagues could get caught up in your drama, and that can lead to long-term career damage. And as unfair as it may seem, that impact is more than likely to be felt most by the nurse in the relationship.

So, let’s go over a few rules to make sure you’re savvy about dating a doctor and don’t come away with professional regrets:

• Keep it quiet. Especially in the early days of a relationship, it’s important that you don’t provide workplace gossip fodder. Don’t text “Hey Stud Muffin” notes to your honey at work, which could actually be grounds for getting fired. Avoid any hand-holding, stolen kisses or other PDA (public displays of affection) on the job. If you go to lunch or take breaks together, help keep speculation under control by inviting other people along sometimes. When dating after hours, don’t go to the usual haunts where other nurses, doctors and medical technicians hang out. Always maintain your professional demeanor when working—no “babe” or “sweetie” when addressing one another. “It’s important to keep it out of the hospital, or wherever you work,” says Sarah Dolloff, a registered charge nurse at Sacred Heart Hospital on the Emerald Coast in Miramar Beach, Fla. “People do gossip at work—especially women. They’ll talk about who they saw together and stuff like that. That’s why you want to make sure you act professionally at all times at work.”
• Check the employee handbook. Always make sure you’re cool with your organization’s policy regarding workplace dating. Most nurses don’t report to doctors, but if there’s any supervisory role between you and your honey, you may be violating a rule regarding supervisors dating subordinates. “When I worked in a university hospital, we socialized quite a bit with the male residents and interns,” Dolloff says. “But in a community hospital, it’s much more formal. You’ve got to be aware of what’s okay and what’s not okay in that setting.”
• Set some ground rules. While it may sound unromantic, make sure anyone you date from work understands that you want to be discreet, and if it doesn’t work out, you still want to be discreet. “There are some hospitals that are so big, the two people might never see each other at work. But if you’ve got an orthopedic doctor working with an orthopedic nurse, for example, they’re going to be running into each other all the time,” Dolloff says. “I’d have an issue with a nurse who didn’t behave professionally when she worked with someone she was dating.”

And while fuming silences, spats in the hallway, tears and nasty remarks after a bad breakup make for good TV, they can give supervisors digestive problems. Be clear up front that no matter how the relationship works out, you want to protect your career. Make sure that viewpoint is heard and respected before moving forward, or you could be heading for real heartbreak—both personally and professionally.

Image: OJO Images | Getty Images

We’re all looking for ways to improve when it comes to hand washing. No fear. Where there’s a will, there’s a way. A little statistical analysis and self-reflection never hurt the cause, either. In this edition of MD/RN, Nurse Rebekah and Dr. Brady stop to look at the published evidence for hygienic practices in their department, the ED—and also come clean about their own hand-washing habits.

Nurse Rebekah: Dr. Semmelweis preached it, Florence Nightingale advocated for it and Purell has made a fortune off it: hand washing. It’s so simple, and yet we fail at it all the time. One study in the Annals of Emergency Medicine found that nurses in the emergency department only washed their hands 58.2 percent of the time when it was deemed necessary. Embarrassing? Yes. But at least nurses did better than the 18.6 percent of residents and 17.2 percent of attending physicians who met the mark. Subsequent studies could be cited, but this isn’t a term paper (I have enough of those to write). The general theme is that none of us is that great at hand washing, but at least nurses seem to be a heck of a lot better at it than others.

Dr. Brady: I plead guilty as charged. I’m a “germophobe” to some degree, so I’m probably a better hand washer than most of my colleagues, and still I’m certain I’m far from perfect. I would bet I’m above the 50 percent mark, though. The number one reason for failure, of course, is time constraints. In the ED it’s often rush, rush, rush. An alcohol-based rub certainly helps—when there’s one nearby and it’s not empty.

There really is no excuse for not washing your hands. This simple act protects both you and your patients. Hopefully in our failure, we’re at least prioritizing correctly and not skipping hand hygiene after touching patients with obviously contagious conditions.

By the way, it’s important to know that alcohol-based rubs have certain limitations. They don’t work for Clostridium difficile, a bacteria that causes a potentially life-threatening diarrheal illness, and they aren’t as good as soap and water for influenza (per a 2009 study by Grayson).

[main image: Chris Ryan | OJO Images | Getty Images]

What can hospitals and clinics do to make it easier for healthcare workers to wash their hands 100 percent of the time it’s deemed necessary? Does your unit have a clever solution?

Image: Michael Hitoshi | Digital Vision | Getty Images

What do they teach medical students in school?  Obviously there isn’t a class for common sense.  No class for copier/fax usage.  Penmanship, bedside manner, courtesy?

Today I had a physician call me from another floor to ask me to do an incident report on a mistake one of his residents made.  First thing I asked him was why he didn’t come talk to me when he was on my unit right outside my door five minutes before he called me.  No answer.  I told him that incident reports were to be completed by the person that finds the error; it is not just a nursing job.  He stated to me he did not have enough time.  “Excuse me Dr. but you had time to call me about this when you could have completed the report by now.”  No Answer.

I don’t know why physicians think so little of nurses, but at the same time rely on us so much.  We talk about critical thinking from day one in nursing school and work on developing those skills throughout our education and career.  Then you come to work and meet a physician with years and years of education that can’t think their way out of a paper sack.

Granted, working in a teaching hospital can be much worse when dealing with this type of nonsense.  Between the medical students, residents, fellows, attending and all the mid-level practitioners, it is exhausting teaching them all how to print a document and then fax it.

Maybe it is too much education that causes them to not think anymore.  Maybe it is the long hours of residency that rots the brain.  Who knows, but you would think that people that smart could figure it out.

By the way…….I didn’t do that incident report.  Score one for nursing!

[main image: flashfilm | Digital Vision | Getty Images]

Image: iStockphoto

RN: So I was at the gym today (finally a day off!), and I was half watching the Oprah show and half watching this really sweaty guy because I thought he was going to fall off the treadmill and code. (Side note: Please, people, if you haven’t been to the gym since 2003, for the sake of us medical personnel, don’t go full blast on your first time out. You’re just giving all of us angina.). The topic of Oprah’s discussion was MRSA, and the more I thought about the perils of MRSA and the more I watched Mr. I’m-Gonna-Lose-70-Pounds-Today, who was sweating his own saltwater pool, the more I was reminded of my first encounter with an MRSA patient a number of years ago.

She was a young girl who was an avid spinner, and couldn’t attend her favorite gym class of late due to this ever-growing, ever-painful red lump on her right buttock. So she came to the ED, and lo and behold, it was a pretty good-size abscess. When the doc injected the lidocaine, it was just enough to release some much pent-up pressure. There, from this young girl’s haunches, sprung forth a fountain of blood and pus similar to the fountains at The Bellagio, but without the obvious beauty and background vocals of Celine Dion and Andrea Bocelli. An obsession was born.

MD: Ew, I hate this stuff. I guess some people like to watch the stuff drain, but honestly, the stuff is stinky and awful. What’s more, I hate to have to drain an abscess, because even though I know I’m helping the patient, I have to be cruel to be kind. I always give some morphine or dilaudid first unless they have to drive home, but that injection still hurts. You nurses are lucky here. You don’t have to inject the lidocaine (it burns) and you can stand a few feet back from the bubbling pus.

RN: Yes, the lido burns, but put a little neut in it! I still don’t understand why this isn’t done all the time. I have since become what I like to call an abscess aficionado. I can usually tell by the amount of pus and the smell whether it is MRSA or not. I have a hard and fast rule: No doc is allowed to I&D my patients without my presence because it’s like missing the opening act of the Academy Awards—the best part!

MD: When I treat a patient for an abscess, it’s definitely a teachable moment. They never want to have to come back for another I&D. So I tell them how they can avoid this in the future: Keep clean, shower often and never pick or squeeze anything unless you wash your hands immediately beforehand and immediately afterward. People just don’t understand how dirty their hands and fingernails are. Even with no visible dirt, per se, Staph aureus is lurking around every corner.

RN: Over the years, we’ve seen MRSA grow from a hospital problem into a community problem. This nasty mutant bug can very easily be picked up from the gym (sweaty bottom + tiny, dirty seat + open pores = trip to the ED for serious antibiotics). Average, ordinary people are contracting this insolent bacteria and just can’t shake it.

MD: Although Staph aureus infections have been around since before the dark ages, and even yours truly had to go to the emergency department as a teenager for the type of cure only a gleaming 11-blade can offer, we’re definitely in the midst of an MRSA epidemic. And unlike some of the other current epidemics such as HIV and hepatitis C, which primarily target those who share needles or don’t protect themselves during sex, MRSA targets everyone.

Athletes are definitely at risk, but so are we.

In fact, as healthcare workers, we’re probably at higher risk than most. A friend of mine who’s a nurse developed an MRSA infection after a minor hand surgery. We’re around it every day. So if we don’t take the proper precautions, it means trouble.

I’m almost tired of all the articles on the subject. I get it. I should wash my hands frequently at work, and when I get home, wash everything else. And of course, taking precautionary measures during patient care, including using the correct barriers when dealing with open lesions and putting patients with a history of MRSA infection on isolation to protect patients and staff.

RN: I can’t help but wonder what part we played in this growing problem. I always try to emphasize to my patients on discharge that they MUST TAKE ALL OF THEIR ANTIBIOTICS. Don’t stop taking them when you feel better, don’t save them for another sick day, don’t give up if you miss a dose. Keep going until the bottle is empty! I try to explain to them about these mutant bugs and how serious they are. I also wonder what doctors have done, or haven’t done, to prevent this. Sometimes, people just demand an antibiotic even when everyone from the ED volunteers to the cafeteria staff knows that this person has a virus and, thus, antibiotics are useless. But some docs give in, most likely to win the battle, even though in the long run they may lose the war.

MD: Not me! I know the data. Ninety-five percent of respiratory infections are caused by viruses, and 75 percent of the inappropriate antibiotics in this country are written for URIs. I find that most patients will trust me that they don’t need antibiotics if I take the time to explain why. It takes a few extra minutes of my time, something that is precious at work, but I think it’s worth it. I have a whole shpiel I give, which I won’t reproduce here, and it usually works. I want to win both the battle and the war. I want to be part of the solution and the cure. Of course, it doesn’t always work, but I’m batting around 900 these days. For abscesses, there’s a bit more controversy. According to most experts, simple abscesses actually don’t require antibiotics after an I&D. However, there is data to suggest that antibiotics may help eradicate the carrier state that exists between acute infections. Sounds worth it to me.

RN: One thing nurses and doctors can always do better is wash their hands. I’m going to go out on an anecdotal limb here and say that nurses are better at being hygienic than doctors are. Actually, that’s not really a limb—it has been shown in quite a few studies—but we’ll have to save that for a future installment of MD/RN! Have a great day, people, and remember: Stay safe, stay sanitized.